Supremely right

The Supreme Court holds that the Affordable Care Act passes constitutional muster.

June 29, 2012 

In the end, it was a defining characteristic of government – the power to tax – that saved the Affordable Care Act’s constitutional bacon in the Supreme Court. That and Chief Justice John Roberts’ disinclination to overturn from the bench the historic votes on the House and Senate floors that extended health insurance coverage to nearly all Americans.

The result was a crucial victory Thursday for a national goal Democrats had pursued for decades. But more than a win for a political party, this was a big step toward the promise of better health care for all of us, even if challenges remain. High and rising health care costs must be addressed, and kinks in the lengthy Affordable Care Act must be ironed out as they come up.

But – assuming a President Romney doesn’t take office in January with enough support to overturn the law – no longer will the United States remain just about the only advanced country lacking universal coverage. No longer will the worst aspects of our often-outstanding health care system work against us, bankrupting some unfortunate people who are badly hurt or fall seriously ill.

Help for families

No longer will children in families that make too much to qualify for existing Medicaid but too little to afford private insurance go uncovered in the face of unaffordable medical costs. No longer will “pre-existing” ills disqualify people from coverage. No longer will those who lose or change their jobs – and employer-provided health insurance – be left out in the cold. Real, tangible benefits will reach tens of millions more Americans.

Also, because the Affordable Care Act was upheld, the advances made as the fledgling act phases in will remain in place, including a family’s ability to insure offspring until age 26.

Those gains would have been tossed aside or left to the tender mercies of insurers if the decision – if Chief Justice Roberts – had gone the other way. By the slimmest of margins, 5-4, Roberts and the court’s four liberal members ruled with convincing logic that the route Congress took to expand coverage was indeed constitutional.

The individual mandate, Roberts wrote, doesn’t pass muster based on the congressional power to regulate commerce, yet it is, he wrote, at its core a form of tax – and if a government can do anything, it can tax. Whatever it’s called (and Republicans will make much of this new Democratic “tax”) the requirement that everyone have coverage makes sense in insurance terms. To keep costs low for all, the insurance pool needs to be wide and deep, and folks can’t be allowed to buy in only when they’re about to need costly care.

Bay State mandate

Back when Congress was developing the health reform package, the issue of the mandate’s constitutionality seemed peripheral. Hadn’t Republicans originally proposed it? And didn’t then-Gov. Mitt Romney of Massachusetts cast the requirement as a tool to assure that people took responsibility for covering their own health care costs?

Yes and yes. But Congress stepped smack into an area of law – the government’s powers under the Constitution’s Commerce Clause – that conservatives on the Supreme Court have been itching to reduce. In Thursday’s ruling they did, with Roberts finding that Congress has no power to compel people to, in effect, buy a product. (But to lay on a tax? That it can do, even if it doesn’t call it a tax.)

Also gaining was an effort to rein in expansion of Medicaid, the federal-state health care program for the poor and disabled. The court said Washington can’t take away the money it contributes to states’ current Medicaid programs if the states reject the Affordable Care Act.

That may tempt Republicans in some states – let’s hope not in North Carolina, where so many people lack coverage – to try to undercut the act. Overall, though, that job will be harder now that the health care law’s constitutionality has passed the Roberts Court’s muster.

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